It’s never been a better time to audit your Pharmacy Benefit Manager (PBM) and the claim payments it makes on your plan’s behalf. With drug price increases expected in 2023 for commercial and employer-sponsored health plans, keeping an eye on things will be vital. CONTINUE READING
If you’re a medical benefit plan manager and hearing about Rx co-pay optimizers, this article is for you. The question our clients have is, how much can an optimizer save my plan? CONTINUE READING
When large and medium-size employers weigh the value of medical claims auditing and continuous claims monitoring service, we remind our clients there are added values to consider.
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There is enormous financial and plan performance value in continuous monitoring of benefit claim payments. When you entrust a health insurer or other administrator to process claims for your self-funded plan, you hand them an open checkbook in many regards. While much of what they do goes as expected, a surprising percentage falls outside of the agreed-on parameters. It means plan members (your employees) may not be receiving the most effective outcomes, and costs can rise needlessly. Some of the processing abnormalities are inadvertent, and others may be more purposeful — because no one thinks you’re watching. CONTINUE READING